Acute Peritonitis Nursing Care Plan & Management

Notes

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Description

Acute peritonitis is an inflammatory process within the peritoneal cavity most commonly caused by a bacterial infection. Types of acute peritonitis include primary and secondary. Primary peritonitis, otherwise known as spontaneous bacterial peritonitis, most commonly occur inpatients with cirrhosis and clinically significant ascites. Secondary peritonitis most commonly occurs as a result of spillage of intestinal, biliary, or urinary tract contents into the peritoneal space as a result of perforation, suppuration, or ischemic injury. Patients at risk for developing secondary peritonitis include those with recent abdominal surgery, a perforated ulcer or colon, a ruptured appendix or viscus, a bowel obstruction, a gangrenous bowel, or ischemic bowel disease.

Signs and Symptoms

Patient assuming a knee-flexed position and complaining of severe localized or generalized abdominal pain.

Nursing Interventions

Rationale: Aids in evaluating degree of fluid deficit or effectiveness of fluid replacement therapy and response to medications.

Maintain accurate I&O and correlate with daily weights. Include measured losses. Include measurements from gastric suction, drains, dressings, Hemovacs, diaphoresis, and abdominal girth for third spacing of fluid.

Rationale: Reflects overall hydration status. Urine output may be diminished because of hypovolemia and decreased renal perfusion, but weight may still increase, reflecting tissue edema or ascites accumulation. Gastric suction losses may be large, and a great deal of fluid can be sequestered in the bowel and peritoneal space (ascites).

Measure urine specific gravity.

Rationale: Reflects hydration status and changes in renal function, which may warn of developing acute renal failure in response to hypovolemia and effect of toxins. Many antibiotics also have nephrotoxic effects that may further affect kidney function and urine output.

Rationale: Replenishes circulating volume and electrolyte balance. Colloids (plasma, blood) help move water back into intravascular compartment by increasing osmotic pressure gradient.Diuretics may be used to assist in excretion of toxins and to enhance renal function.

Nursing Interventions

Rationale: Changes in location or intensity are not uncommon but may reflect developing complications. Pain tends to become constant, more intense, and diffuse over the entire abdomen as inflammatory process accelerates; pain may localize if an abscess develops.

Rationale: Reduces nausea and vomiting, which can increase intra-abdominal pressure and pain.

Administer medications as indicated:

Analgesics, narcotics;

Rationale: Reduce metabolic rate and intestinal irritation from circulating or local toxins, which aids in pain relief and promotes healing. Pain is usually severe and may require narcotic pain control. Analgesics may be withheld during initial diagnostic process because they can mask signs and symptoms.

Antiemetics: hydroxyzine (Vistaril);

Rationale: Reduce nausea and vomiting, which can increase abdominal pain.

Antipyretics: acetaminophen (Tylenol).

Rationale: Reduce discomfort associated with fever.

Nursing Diagnosis

Risk for Imbalanced Nutrition: less than body requirements

Risk factors may include

Nausea/vomiting, intestinal dysfunction

Metabolic abnormalities; increased metabolic needs

Possibly evidenced by

Not applicable. A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred and nursing interventions are directed at prevention.

Desired Outcomes

Maintain usual weight and positive nitrogen balance.

Nursing Interventions

Auscultate bowel sounds, noting absent or hyperactive sounds.

Rationale: Although bowel sounds are frequently absent, inflammation and irritation of the intestine may be accompanied by intestinal hyperactivity, diminished water absorption, and diarrhea.

Monitor NG tube output. Note presence of vomiting, diarrhea.

Rationale: Large amounts of gastric aspirant and vomiting and diarrhea suggest bowel obstruction, requiring further evaluation.